Provider Demographics
NPI:1578391504
Name:CHATELAIN, RAVEN LAYNE
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:LAYNE
Last Name:CHATELAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E MARK ST
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2414
Mailing Address - Country:US
Mailing Address - Phone:318-240-7293
Mailing Address - Fax:318-240-7293
Practice Address - Street 1:110 E MARK ST
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2414
Practice Address - Country:US
Practice Address - Phone:318-240-7293
Practice Address - Fax:318-240-7293
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator